Images in Clinical Medicine
Acute Rheumatic Fever with Erythema Marginatum
Makoto Saito, Shuji Hatakeyama
N Engl J Med 2016; 375: 2480
DOI: 10.1056/NEJMicm1601782
A previously healthy 36-year-old man presented with a 1-month history of fever and pain in both shoulders and knees, which had been preceded by a sore throat 2 weeks before the onset of fever. Laboratory studies were notable for a white-cell count of 13,800 per cubic millimeter (85% neutrophils), a C-r...

Images in Clinical Medicine
Uterine Rupture with Protruded Legs in a Large Amniocele
Pierre-Emmanuel Bouet, M.D., CharlyneHerondelle, M.D.
N Engl M Med 2016; 375; e51
A 33-year-old asymptomatic woman (gravida 6, para 5) presented at 22 weeks of gestation with a large herniation of the amniotic sac through the left uterine wall that was detected by routine ultrasonography. She had had five previous cesarean sections through a transverse incision of the lower ut...

Images in Clinical Medicine
Diagnosing Myasthenia Gravis with an Ice Pack
Wendy W. Liu, Adam Chen
N Engl J Med 2016; 375: e39
DOI: 10.1056/NEJMicm1509523
A 68-year-old man presented with unilateral ptosis and no other symptoms. The neurologic examination revealed ptosis of the left eye after a sustained upward gaze (Panel A). The movements of the extraocular muscles were normal. Myasthenia gravis was suspected, and the ice-pack test was performed with the placement of an ...